See left hand tab for further page:

Dos and don'ts of procurement

---

Latest news 23 October 2009 - new case study added Bidding for Community Services - a second case study, October 2009.  For the full story about successful bid for a new community COPD services from an NHS community provider click here.

---

 

Latest news - 13 October 2009 - The NHS as preferred provider

SHAs and PCTs have been told by David Nicholson to expect a revision to the Procurement Guide and  to competition guidance Principles and Rules of Co-operation and Competition and Necessity - not Nicety.  The revision will take account of the  principle of giving the NHS a fair chance to improve. 

"by setting out a clearer process that will provide an opportunity for
existing providers to improve before opening up to new potential providers”.
This will ensure “everyone knows where they stand and services stand or fall
on the quality they provide”. In practical terms, we will provide guidance to
PCTs on the processes we expect them to follow, which includes engaging
with NHS organisations and their staff and trade union representatives,
coupled with strengthened assurance processes.....

"Our over-riding principle is to provide high quality care for patients delivered
by providers who offer the best care. We remain committed to the
participation of independent and third sector providers where this is the right
model for patients – for example, where we need new services/service
models, or substantial increases in capacity, or to offer increased choice to
patients or to stimulate innovation.

We are committed to treating NHS staff fairly; giving NHS providers the
opportunity to meet commissioner’s needs and thereby doing the best thing
for NHS patients. For new or substantially redesigned services, PCTs would
be expected to engage fully with the existing provider(s) and staff at an early
stage, as well as other potential providers, enabling them to contribute to
service specifications. Only after this would a decision on whether or not to
openly tender take place. When competition is used it should be transparent,
equal, fair and proportionate to deliver the best care to meet the needs of the
local population."....

---

 

The Department of Health issued on 16 May 2008 a Primary Care Trust Procurement Guide for Health Services  which is written to support NHS commissioners in deciding whether and how to procure health services through formal tendering and market-testing exercises. The Guide sets out the policy and regulatory context for procurement, and issues to consider when developing a procurement strategy. The Guide should be read in conjunction with the ‘Principles and Rules for Cooperation and Competition’, published as Annex D of the 2008/9 Operating Framework, and the ‘Framework for Managing Choice, Cooperation and Competition’. 

This states: “The EU Treaty and various Directives on procurement require competition as the mechanism by which contracting authorities ensure equality of treatment, transparency and non-discrimination.  Nevertheless, it remains for each contracting authority to decide whether a formal tender is required for healthcare services. “

It also describes four principles:

Transparency

• Sufficient and appropriate advertising of tenders
• Transparency in making decisions not to tender
• Declaration and separation of conflicts of interest

Proportionality

• Making procurement processes proportionate to the value, complexity and risk of the services contracted, and critically not excluding potential providers through overly bureaucratic or burdensome procedures

Non-discrimination

• Ensuring consistency of procurement rules
• Transparency on timescale and criteria for shortlist and award

Equality of treatment

• All providers and sectors have equal opportunity to compete where appropriate
• Financial and due diligence checks apply equally and are proportionate
• Pricing and payment regimes are transparent and fair

IMPRESS's view  is that what this means is that  commissioners don’t want to destabilise the NHS economy but they do want to raise standards.  So, they might introduce contestability by moving care closer to home or by tendering, or by improving contract detail.

From 1 October 2008, all NHS commissioners in England will be required to post information about tendering opportunities and contract awards on NHS Supply2Health  The public site is  here.   IMPRESS has a log of all tenders for respiratory services.  There have been 11 tenders advertised for COPD since the Supply2Health process began.  

In addition, from 1 October 2008 there is a new Co-operation and Competition panel.  The existence of the panel will increase potential legal challenges to procurement decisions, incentivising PCTs to demonstrate that their processes are open and fair.  PCTs are therefore expected to refer to the Procurement Guide for advice.

February 2009: new Procurement helpdesk launched.

June 2009: new Commercial Operating Model Necessity – not nicety for NHS England launched.  Some services decommissioned and new regional Commercial Support Units established (CSUs), "to help
commissioners raise their game, focusing on World Class Commissioning competencies 7, 9 and 10 – analysing, stimulating and managing healthcare markets, securing and applying procurement skills, and managing contracts effectively as a ‘demanding’ customer. Alongside support, a key element of the offer will be skills transfer, creating permanent PCT capability in these key areas.

CSUs will also be able to help providers.  Note that due to be revised - see October 13 2009 latest news.

Also includes:

New commercial centre within the Department of Health England - the Procurement, Investment and Commercial and Division (PICD) to strengthen commercial and procurement support for the DH and the system. National Procurement Council,with oversight of the delivery of Comprehensive Spending Review 2007 (CSR ‘07) savings, and including professional training and development and procurement policy
A new Strategic Market Development Unit will take responsibility for leadership and support to commissioners in market analysis and market-making.

---

IMPRESS has complemented this with a position paper: Commissioning A Community COPD Service: Lessons for the NHS Based on a case study in Somerset PCT.

This case study is written for clinicians, service  managers and commissioners to illustrate the complexities in commissioning and procuring a new service for people with long term conditions  if existing services do not address patients’ needs.   It is accompanied by a set of suggested “dos and don’ts” on the last page (and see below).  One of the most important of these is to recommend to colleagues that a continuous programme of improvement, which actively engages patients, led by clinicians from primary and secondary care with managerial support, is a simpler, potentially more sustainable approach.  However, if a competitive process is chosen, it offers guidance for bidders on how to make a successful bid and for commissioners on how to develop the market.  

Click here for full document.

See also Dos and dont's of procurement

They have been expanded in light of a second story, Bidding for Community Services - a second case study, October 2009.  For the full story about successful bid for a new community COPD services from an NHS community provider click here.

---

 

Making the case for a focus on respiratory care

For many clinicians and commissioners, the drive to reduce avoidable emergency admissions has led to a review of care for people with COPD.  The  NHS Institute’s Opportunity Locator  gives SHA and PCT level information about numbers of ambulatory care sensitive condition  (ACS) spells and the potential to avoid admission or facilitate earlier discharge.   COPD and asthma feature within the ACS list.  See here.

 

---

Contracts

Principles and rules for co-operation and competition - note these are due to be revised - see October 13 2009 news